The Importance Of CPR In Healthcare

“Autonomy is defined as self-determination and freedom from the control of others and making your life choices” (Morrison, 2011). The principle of autonomy holds that actions or practices tend to be right thus far as they respect or reflect the exercise of self-determination. “Persons and their actions are never fully autonomous, but nevertheless it is possible to recognize certain individuals and their decisions as more or less substantially autonomous” (Organ Procurement & Transplant Network, 2010). With the presentation of the principle of autonomy there are a few considerations such as, refusal of an organ and the right to do so, directed donation allocation, the processes of organ donation, and allocation rules that enable patients to make informed decisions.

Though ethics committees have been helpful, scores of physician-patient disagreements end up in the U.S. court system with inconsistent results. The states adopted individual “statutes regulating DNR orders and their provisions vary in analysis throughout the U.S.” (Bishop, Brothers, Perry & Ahmad, 2010). One ethical dilemma that is constant in emergency rooms, the intensive care unit and terminally ill persons is a futility of treatment. In the case of CPR/DNR, New York State wanted to enact a law that describes the decisive responsibilities of the patient, and the family or surrogate, and physician. “In April 2003, the New-York Attorney General asserted that the DNR law would require a physician to obtain a consent of the patient’s health care surrogate before entering a DNR order, even when the physician

A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.

The process of deciding when a terminally ill patient should die lies within the patient, family members, and the

Mr. B, the patient’s brother is Mr. E’s designee to make healthcare decisions in the event that he is unable to do so for himself. He is left to make these decisions without a code of ethics or without medical knowledge. He counts on the medical professionals to assist him. He has an ethical obligation to abide by his brothers wishes and directives. He is influenced by his own beliefs and his perceptions of what his brother would want. If he has the good faith belief that his brother did not understand the need for the ventilator or the outcome of refusing the treatment, then it is not unreasonable or unethical

The importance of end of life issues and decisions are now being discussed at the time of admission to most acute care and long term acute care facilities. More attention is being placed on these specific decisions to ensure that the patient's

(TCO D) A patient's family may be actively involved in end-of-life decisions for patients who are incapacitated or incompetent. Compare and contrast two legal cases that address the rights

An important factor when deciding to educate patients is to dispel some of the myths surrounding organ donation. Many people struggle with “discomfort with making a donation decision, lack of motivation to register, concerns about burial, and repugnance associated with death and organ procurement” (Ladin, 2016, p. 156) when thinking about becoming a potential organ donor. Some also worry that if they are organ donors and something unfortunate should happen to them, doctors will not work as hard to save their life. While this can seem like a logical concern, there are many tests done to ensure that patients are actually brain dead before beginning the donation process. There is also the option of circulatory determination of death: “Determination of death can be made after cessation of circulation and respiratory function for two minutes” (Dalal, 2015, p. 45). Making everyone an automatic organ donor would decrease a person’s willingness to learn about the actual procedure and also serve to further perpetuate this common fear. In causing more fear, mandatory organ donation would hurt people instead of helping them.

It is also clear that while making these decisions, the decisions ought to be made based on informed consent (Werth and Crow 195). Sometime, the patient may be experiencing dementia, clinical depression or delirium for which they may be affecting the patient’s decision making capabilities (Werth and Crow 197, 198). If such a person is allowed to make their right-to-die decision, this may be done without the patient having comprehensive information before consent and thus should not be encouraged (Werth and Crow 198).

The current health situation should be explained in a non-technical way so the patient (if possible) family, and or valid surrogate can understand every aspect. The physician should also help them understand when there is no hope for recovery. Most often the organs are no longer functioning, or there is little to no brain activity; at this point suffering potentially outweighs the probability of recovery. Medical teams most often realize that the focus should be on comfort, rather than extending a dying life. This decision comes with a great deal of uncertainty, and will always be hard, no matter what age of the patient, or the circumstances. Kathryn Kosh, MD explains that, “Ready access to advanced modern technology has changed death from an event to a process… Defying death requires payment [in the form of] pain and discomfort or in an unacceptable decline in the quality of life.” Often times physicians will not prescribe treatment in the first place knowing that this option will not benefit the patient, prolong suffering; and will likely end in termination anyway. Therefore, allowing the nature of the illness or injury to take its own course of action. Another point of interest regarding this topic is that medical teams realize in most cases, that providing an ethical and dignified death can be just as rewarding as administering aggressive measures to save a

I believe that the immediate family members should be given the option to be present during resuscitation of the patient. I believe that it is the immediate family members’ right to be present if they

In end-of-life scenarios, where the patient may not be able to communicate their wishes, decisions must be made either by the healthcare professional(s) or family member(s). However, who gets to decide or where the line should be drawn are not always clear. Consequently, not all decisions may be ethically permissible. To illustrate, I will discuss a scenario in which physicians and family are not in agreement. Upon proving a brief summary and explaining the ethical dilemma, I will provide moral reasons for two ethically permissible choices from which, by referencing the principle of autonomy and Utilitarianism, will determine which course of action ought to be carried out.

The principle of autonomy states; “individuals have the right to make choices about their own lives” (Kozier et al, 2010.p.79). In health care, this means health care providers must honour the person’s right to choose methods or approaches to diagnosis or treatment (Kozier et al, 2010). Moreover, by not giving the client, the right to make her own decision this could cause anxiety and physiological effect to both parties. Which disregard the World Health Organization (WHO), definition of quality end of life care as the "active total care of patients whose disease is not responsive to curative treatment" (Sepúlveda, Marlin, Yoshida, & Ullrich, 2002). This definition includes meeting the psychological, social, and spiritual needs for both patients and families (Sepúlveda et al, 2002). In addition, the nurse did not put the beneficence principle in action, which “is the obligation to do good” (Kozier et al, 2010, p.80). Nurses have a duty to implement actions that benefit their client’s best interest (Kozier et al, 2010). It lays the groundwork for trust that society places in nursing professional, and provides nursing’s context and justification (Burkhardt & Nathaniel, 2002). This principle seems straight forward, but it is actually very complex. Should we determine what is good- by subjective, or by objective, means? So, when people disagree about what is good, whose opinion counts? In this case, the client, and not the family because she has the

A Do not resuscitate (DNR) order is a legal document written by a licensed physician, which is developed in consultation with the patient, surrogate decision maker, and attending physician. This document indicates whether the patient will receive resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives, in the setting of cardiac and/or respiratory arrest. A DNR can also be referred as a no code when identifying a patient’s resuscitation status. If a patient has an existing DNR it allows the resuscitation team, taking care of the patient, to either withhold or stop any resuscitation measures, and therefore respect the patient’s wishes. Historically, DNR orders did not become active in the care of patients until 1974, when it was identified that patients who received CPR, and survived, had significant morbidities (Braddock & Derbenwick-Clark, 2014). Braddock and Derbenwick-Clark further noted, the American Heart Association (AHA) recommended that physicians, in consultation with the patient, family, and or surrogate, place on the patients chart when CPR was not indicated. This documentation is now what we refer to as the DNR order and has become the standard to allow autonomous respect for patients, and their families, to make informed medical decisions. Therefore, the purpose of this paper is to discuss the legal aspects, ethical issues, and the application surrounding the DNR order.

As an administrator I would need to take into consideration the patient’s autonomy, autonomy is recognizing an individual’s right to make his/her own decisions about what is best for them regarding their health care (Pozgar, 2012). The patient’s rights always should be considered before any decisions are made by any other family members. In this scenario it is clear that the patient is unable to make any decisions, the patient has suffered a serious brain damage, and although it is not complete brain death, we must determine how to proceed.